Effective 01/01/2017 majority of the drugs with quantity limits will be switching from Period To Date (PTD) logic to Max Daily dose (MDD) logic. PTD Quantity is used to set limitations on the quantity received within a period of time specified. If the member has not exceeded the maximum quantity within that time frame, they are eligible to receive the drug. MDD quantity is the maximum number of units of the drug allowed per day.

If rejection is received please verify that the day supply submitted on the claim is correct. If the allowed max daily dose is truly exceeded, please communicate this information to the patient and/or physician so the physician may initiate the prior authorization request as needed.

You should have received a notice on Thursday of last week that announced that the latest data update was made available in EQuIPP on Thursday, December 15th. 

As you start to explore your dashboards this month, we wanted to follow-up on our Service Notice from Friday to let you know that most of the updates to your EQuIPP performance information completed on Friday. One data provider is continuing to be updated throughout the day today (Monday, December 19th). As a result of the updates, you may notice a change in your performance information for the new measurement period and potentially a brief disruption in the presentation of your EQuIPP Dashboard.

This week's Advocacy Update includes information on changes to the DEA's registrant renewal process, resources for states regarding Medicaid reform, and much more!

Dear Valued Provider,

Effective January 1, 2017, Prime will be utilizing a new concurrent DUR (cDUR) service designed to help identify cases of Apparent Opioid Misuse. This service calculates the cumulative daily morphine equivalent dose (MED) across the submitted claim and selected historical claims. The service flags claims that would cause a Covered Person’s cumulative opioid medication use to exceed pre-defined thresholds of MED for consecutive days and associates with prescriptions from multiple Prescribing Providers filled by multiple Participating Pharmacies.

*Please see attached PDF for more information.